Preterm Contractions Checklist
Preterm Contractions Checklist 1. Is the gestational age less than 37 weeks? [select value="Unknown|No|Yes"] <-- Are dates certain? [select value="Unknown|No|Yes"] <-- Established by LMP or early ultrasound? [textarea] 2. Are the membranes ruptured? [select value="Unknown|No|Yes"] <-- History of leaking fluid? [select value="Unknown|No|Yes"] <-- Positive nitrazine test result? [select value="Unknown|No|Yes"] <-- Ferning of fluid on microscopy? [select value="Unknown|No|Yes"] <-- Positive amniotic protein test result? [select value="Unknown|No|Yes"] <-- Ultrasound assessment shows low amniotic fluid? [select value="Unknown|No|Yes"] <-- Ultrasound-guided transabdominal instillation of indigo carmine dye into the amniotic sac, if available, shows dye outside the amniotic sac? [textarea] 3. Is the patient in labor? [select value="Unknown|No|Yes"] <-- Regular contractions [select value="Unknown|No|Yes"] <-- Progressive dilation and cervical effacement? [textarea] 4. Is there an infection? [select value="Unknown|No|Yes"] <-- Group B streptococcus carrier status? [select value="Unknown|No|Yes"] <-- Urinary tract infection? [select value="Unknown|No|Yes"] <-- Bacterial vaginosis? [select value="Unknown|No|Yes"] <-- Trichomoniasis? [select value="Unknown|No|Yes"] <-- Gonorrhea? [select value="Unknown|No|Yes"] <-- Chlamydia? [textarea] 5. What is the likelihood that the patient will deliver prematurely? [select value="Unknown|No|Yes"] <-- Fetal fibronectin test negative? [select value="Unknown|No|Yes"] <-- Cervical length of at least 3 cm on ultrasonagraphy? [textarea] [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"] Reference: [link url="https://www.ncbi.nlm.nih.gov/pubmed/20148502" memo="#1"] Sayres WG Jr. Preterm labor. Am Fam Physician. 2010 Feb 15;81(4):477-84. [/conditional]
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